Iatrogenic Lutembacher's syndrome revisited.

L acerations or tears of the interatrial septum are a recognized complication of mitral valve replacement surgery; however, the first report of iatrogenic Lutembacher's syndrome was by Dr. John Ross Jr. and colleagues from the National Institutes of Health.1 Their series included three patients who had acquired mitral stenosis and developed a persistent atrial septal defect after transatrial septal catheterization. At the time, persistent atrial septal defect was an unusual complication of transatrial septal catheterization because it had not been seen, previously, in more than 800 of these procedures performed at the National Institutes of Health. Two articles in Circulation call our attention to a new iatrogenic cause of Lutembacher's syndrome, balloon valvuloplasty of the mitral valve by the transatrial septal approach.23 Originally, Lutembacher's syndrome was the combination of congenital atrial septal defect and acquired rheumatic mitral